Laminar hook insertion device

ABSTRACT

A surgical hook insertion device includes an elongate body defining a lumen therethrough and an actuation assembly. The elongate body has a retaining portion configured and dimensioned to releasably retain a laminar hook therein. The actuation assembly includes an actuation rod and an actuator member. The actuation rod is slidably disposed within the lumen of the elongate body. The actuator member is operatively coupled with the actuation rod and is slidably mounted on the elongate body, wherein the actuation assembly is transitionable between a first position in which a portion of the actuation rod engages the laminar hook releasably disposed in the retaining portion and a second position in which the actuation rod disengages the laminar hook.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. patent application Ser. No.13/209,542, filed on Aug. 15, 2011, now U.S. Pat. No. 9,247,962, theentire contents of which are incorporated by reference herein.

BACKGROUND

1. Technical Field

The present disclosure relates to an orthopedic surgical device, andmore particularly, to a laminar hook insertion device.

2. Background of Related Art

Spinal implant systems have been developed to achieve immobilization ofvertebral bodies of the spine in a particular spatial relationship tocorrect spinal irregularities and to restore stability to traumatizedareas of the spine. These spinal implant systems may be classified asanterior, posterior, or lateral implants. As the classificationsuggests, lateral and anterior assemblies are coupled to the anteriorportion of the spine, which is the sequence of vertebral bodies.Posterior implants are attached to the back of the spinal column,generally by coupling to the pedicles via screws, or by means of hookswhich attach under the lamina and entering into the central canal. Ineither case, the implants generally include elongate support rodelements which are coupled to the screws or hooks to immobilize severalsequential vertebrae, for example to hold them stable so that adjacentbones may be fused with bone graft.

Such hook and rod assemblies generally include a plurality of hookshaving rounded blade portions, flat extending members of which areinserted posteriorly under the lamina between the transverse process andthe spinous process. The hooks further include upper body portions towhich the support rod may be coupled. The rod extends along the axis ofthe spine, coupling to each of a plurality of hooks via receivingportions of their bodies. The aligning influence of the rod forces thespine to which it is affixed, to conform to a more proper shape.

It has been identified, however, that a considerable difficulty may beassociated with inserting hooks under sequential lamina along amisaligned curvature and simultaneously precisely aligning their rodreceiving portions with the rod to receive the rod therethrough withoutdistorting, tilting, rotating, or exerting undesired translationalforces on the hooks. Correction of this difficulty requires the timeconsuming and difficult tasks of reshaping the rods or repositioning thehooks, each of which is understood to require considerably longeroperating time, which is known to increase the incidence ofcomplications associated with surgery. Accordingly, there is a need fora device that facilitates the process of inserting hooks undersequential lamina.

SUMMARY

In accordance with an embodiment of the present disclosure, there isprovided a surgical hook insertion device including an elongate body andan actuation assembly. The elongate body defines a lumen therethrough.The elongate body includes a retaining portion configured anddimensioned to releasably retain a laminar hook therein. The actuationassembly includes an actuation rod and an actuator member. The actuationrod is slidably disposed within the lumen of the elongate body. Theactuator member is operatively coupled with the actuation rod and isslidably mounted on the elongate body, wherein the actuation assembly istransitionable between a first position in which a portion of theactuation rod engages the laminar hook releasably disposed in theretaining portion and a second position in which the actuation roddisengages the laminar hook.

The surgical hook insertion device may further include a biasing member,wherein the biasing member urges the actuation assembly to the firstposition. The elongate body may define a cavity configured anddimensioned to enable sliding movement of a pin coupling the actuationrod and the actuator member therein.

The retaining portion of the elongate body may include a seatingprotrusion adapted to engage and retain a hooked portion of the laminarhook. The seating protrusion may conform to the contour of the hookedportion of the laminar hook. In addition, the retaining portion mayinclude a pair of support plates engaging lateral sides of the seatingprotrusion. Each of the pair of support plates may define a grooveconfigured to retain a portion of the laminar hook therein.

The lumen defined in the elongate body may include a first portion and asecond portion. The first portion of the lumen may have a largerdiameter than that of the second portion. The actuation rod may includea first portion and a second portion. The first portion of the actuationrod may have a larger diameter than that of the second portion. Thefirst and second portions of the lumen may be configured and dimensionedto receive the first and second portions of the actuation rod therein,respectively.

The surgical hook insertion device may further include a handle memberdefining a channel therethrough. The channel may be dimensioned toreceive the first portion of the actuation rod. The actuator member maybe disposed adjacent the handle member.

In accordance with another embodiment of the present disclosure, thereis provided a surgical implant insertion assembly including a handlemember, an elongate body, an actuation assembly, and a laminar hook. Thehandle member defines a channel therethrough. The elongate body definesa lumen therethrough. The elongate body is disposed at least partiallywithin the channel of the handle assembly. The lumen is in communicationwith the channel. The elongate body includes a retaining portion adaptedto releasably retain a laminar hook therein. The actuation assemblyincludes an actuation rod and an actuator member. The actuation rod isslidably disposed within the lumen of the elongate body. The actuatormember is operatively coupled with the actuation rod. The actuatormember is slidably mounted on the elongate body assembly. The laminarhook includes a hooked portion and a head portion. The hook portiondefines a recess configured and dimensioned to releasably engage aportion of the actuation rod, wherein the actuation assembly istransitionable between a first position in which a distal portion of theactuation rod engages the laminar hook in the retaining portion and asecond position in which the actuation rod disengages the laminar hook.

The surgical implant insertion assembly may further include a biasingmember disposed in a proximal portion of the elongate body, wherein thebiasing member urges the actuation assembly to the first position. Theelongate body may define a cavity adjacent the handle member, the cavityconfigured and dimensioned to enable sliding movement of a pin couplingthe actuation rod with the actuator member. The retaining portion of theelongate body may include a seating protrusion adapted to engage andretain a hooked portion of the laminar hook. The seating protrusion mayconform to the contour of the hooked portion of the laminar hook. Theretaining portion may include a pair of support plates engaging lateralsides of the seating protrusion. Each of the pair of support plates maydefine a groove configured to retain a portion of the laminar hooktherein.

In addition the lumen defined in the elongate body may include a firstportion and a second portion. The first portion of the lumen may have alarger diameter than that of the second portion. The actuation rod mayinclude a first portion and a second portion. The first portion of theactuation rod may have a larger diameter than that of the secondportion. The first and second portions of the lumen may be configuredand dimensioned to receive the first and second portions of theactuation rod therein, respectively. The head portion of the laminarhook may define a bore configured and dimensioned to receive a bonescrew therein.

In accordance with another aspect of the present disclosure, there isprovided a method of stabilizing the spine. The method includesproviding a surgical hook insertion device including an elongate bodyand an actuation rod. The elongate body defines a lumen therethrough.The elongate body has a retaining portion configured and dimensioned toreleasably retain a laminar hook therein. The actuation rod is slidablydisposed within the lumen of the elongate body, wherein the actuationrod is transitionable between a first position in which a portion of theactuation rod engages the laminar hook releasably disposed in theretaining portion and a second position in which the actuation roddisengages the laminar hook. The method further includes positioning thelaminar hook to a bone, implanting a bone screw into the bone throughthe laminar hook, inserting a connecting rod into a connecting rod slotin the bone screw, and locking the connecting rod in the connecting rodslot in the bone screw.

The method may further include bending the connecting rod prior toinserting a connecting rod into a connecting rod slot in the bone screw.In addition, bending the connecting rod may include bending theconnecting rod to conform to a desire contour of the spine.

In an embodiment, the spinal hook insertion device may further include abiasing member disposed in a proximal portion of the elongate body,wherein the biasing member urges the actuation rod to the firstposition. Furthermore, the spinal hook insertion device may include anactuator member operatively coupled with the actuation rod and slidablymounted on the elongate body. Moreover, the spinal hook insertion devicemay further include a laminar hook including an arched portion and ahead portion. The arched portion may define a recess configured anddimensioned to releasably engage a portion of the actuation rod. Thehead portion of the laminar hook may include a threaded bore configuredand dimensioned to receive therethrough the bone screw. In particular,implanting a bone screw into the bone through the laminar hook mayinclude inserting the bone screw through the threaded bore defined inthe head portion of the laminar hook. Positioning the laminar hook to abone may include positioning the arched portion of the laminar hook onan undersurface of the lamina. Alternatively, positioning the laminarhook to a bone may include positioning the arched portion of the laminarhook around the pedicle.

BRIEF DESCRIPTION OF THE DRAWINGS

Various embodiments of the present disclosure are described hereinbelowwith reference to the drawings, wherein:

FIG. 1 is a perspective view of a laminar hook insertion device inaccordance with an embodiment of the present disclosure;

FIG. 2 is a perspective view of the laminar hook insertion device ofFIG. 1 with a laminar hook removed from the insertion device;

FIG. 3 is a top view of the laminar hook insertion device of FIG. 2;

FIG. 4 is a side cross-sectional view of the laminar hook insertiondevice of FIG. 2;

FIG. 5 is an exploded perspective view of the laminar hook insertiondevice of FIG. 2 with parts separated;

FIG. 6 is a side view of an elongate body assembly of the laminar hookinsertion device of FIG. 2;

FIG. 7 is a longitudinal cross-sectional view of the elongate bodyassembly of FIG. 6 cut along a section line of 7-7 in FIG. 6;

FIG. 8 is a perspective view of the elongate body assembly of FIG. 6illustrating a retaining portion thereof having support plates attachedthereto;

FIG. 9 is a perspective view of the elongate body assembly of FIG. 8illustrating the retaining portion with parts separated;

FIG. 9A is a perspective view of the area of detail indicated in FIG. 9;

FIG. 10 is a top view of the laminar hook insertion device of FIG. 1having a laminar hook releasably attached thereto;

FIG. 11 is a side cross-sectional view of the laminar hook insertiondevice of FIG. 10;

FIG. 12 is a perspective view of the laminar hook insertion device ofFIG. 1 illustrating detachment of the laminar hook;

FIG. 13 is a perspective view of the laminar hook for use with thelaminar hook insertion device of FIG. 1;

FIG. 14 is a perspective view of the laminar hook of FIG. 13 engagedwith a pedicle screw; and

FIG. 15 is a perspective view of a vertebral body illustrating use ofthe laminar hook of FIG. 12 shown in phantom.

DETAILED DESCRIPTION OF EMBODIMENTS

Embodiments of the present disclosure will now be described in detailwith reference to the drawings, in which like reference numeralsdesignate identical or corresponding elements in each of the severalviews. As used herein, the term “distal,” as is conventional, will referto that portion of the instrument, apparatus, device or componentthereof which is farther from the user while, the term “proximal,” willrefer to that portion of the instrument, apparatus, device or componentthereof which is closer to the user. In addition, the term “cephalad” isused in this application to indicate a direction toward a patient'shead, while the term “caudad” indicates a direction toward the patient'sfeet. Further still, for the purposes of this application, the term“medial” indicates a direction toward the middle of the body of thepatient, while the term “lateral” indicates a direction toward a side ofthe body of the patient, i.e., away from the middle of the body of thepatient. The term “posterior” indicates a direction toward the patient'sback, while the term “anterior” indicates a direction toward thepatient's front. In the following description, well-known functions orconstructions are not described in detail to avoid obscuring the presentdisclosure in unnecessary detail.

With reference to FIGS. 1-3, an embodiment of the present disclosure isshown generally as a laminar hook insertion device 10 defining alongitudinal axis “A-A.” Device 10 is configured to operatively retainand release a laminar hook 50 utilized to provide coupling of aconnecting rod 70 (FIG. 15) to the spine by being anchored under thelamina. Device 10 includes a handle assembly 100, an elongate bodyassembly 200 extending distally from handle assembly 100, a retainingportion 300 configured to releasably retain laminar hook 50 therein andan actuation assembly 500 operatively associated with laminar hook 50for release of laminar hook 50 from an actuation rod 560 (FIG. 4) ofactuation assembly 500.

With brief reference to FIGS. 13 and 15, laminar hook 50 is configuredto provide coupling of a connecting rod 70 to the spine, wherein laminarhook 50 is inserted, for example, on the undersurface of the laminawhich forms a shallow arch or an inverted—V shape. In particular,laminar hook 50 includes a head portion 52 which may define a smoothbore opening 56 through which a bone screw 80 (FIG. 14) is inserted intoa bone and an arched portion 54 configured to engage, for example, theundersurface of the lamina. Arched portion 54 conforms to the contour ofa seating protrusion 280 (FIG. 9) of an outer body 220 to help securelyretain laminar hook 50 in a retaining portion 300, as will be describedhereinbelow. Moreover, arched portion 54 defines a groove 55 on eachlateral side thereof and a recess 58 configured and dimensioned tosecurely engage a distal end portion of an actuation rod 560 (FIG. 5),as will be described hereinbelow. An example of a laminar hook isdisclosed in commonly assigned U.S. patent application Ser. No.12/812,829, filed on Aug. 18, 2010, the entire contents of which arefully incorporated herein by reference. In the alternative, it iscontemplated that bore 56 may be threaded to engage threads on the bonescrew or may have a lip disposed in the bore to engage threads on thescrew to deform the lip and lock the screw to the hook. Such a structureis available from K2M, Inc. under the trademark tifix, substantially asdescribed in U.S. Pat. No. 6,322,562 to Wolter.

With reference now to FIGS. 4 and 5, handle assembly 100 includes ahandle member 110 defining a channel 115 therethrough, an anchor member120, and a biasing member 130 disposed in channel 115. In particular,anchor member 120 includes a cap 122 and a stem 124 extending distallyfrom cap 122. Stem 124 includes a neck portion 124 a disposed at adistal portion of stem 124. Neck portion 124 a has a diameter smallerthan that of stem 124. Neck portion 124 a defines a transverse bore 125configured to be in alignment with a lateral bore 112 defined in handlemember 110. Stem 124 is configured and dimensioned to be disposed withinchannel 115 of handle member 110. Cap 122 engages a proximal end portionof device 10 and seals a proximal end of channel 115 of handle member110. In addition, a pin 2 is inserted through lateral bore 112 of handlemember 110 and transverse bore 125 of anchor member 120 to secure anchormember 120 with handle member 110. However, it is envisioned that handlemember 110 and anchor member 120 may be detachably, e.g., threadably,coupled to each other to facilitate repair and maintenance of handleassembly 100. It is further envisioned that handle member 110 may bemonolithically formed with anchor member 120.

With particular reference to FIG. 4, biasing member 130 has a diametercomparable to or smaller than that of neck portion 124 a of anchormember 120. In addition, one end of biasing member 130 is positionedadjacent to a distal portion of neck portion 124 a of anchor member 120.In this manner, biasing member 130 can be compressed against neckportion 124 a secured with handle member 110, as will be describedbelow.

With continued reference to FIGS. 4 and 5, elongate body assembly 200includes an engaging member 240 and an outer body 220 extending distallyfrom engaging member 240. Engaging member 240 is concentrically arrangedwith respect to outer body 220. In particular, engaging member 240 has asmaller outer diameter than that of outer body 220, such that engagingmember 240 is configured and dimensioned to be disposed within at leasta portion of channel 115 of handle member 110, and a proximal endportion of outer body 220 is adapted to be securely fixed to a distalend portion of handle member 110 to enclose a distal end of channel 115.In particular, a proximal end portion of engaging member 240circumferentially surrounds neck portion 124 a of anchor member 120 andprovides a friction fit feature against neck portion 124 a. Under suchconfiguration, biasing member 130 is disposed in a proximal portion ofengaging member 240. Engaging member 240 defines a bore 242 configuredand dimensioned to receive pin 2, whereby elongate body assembly 200 issecurely coupled with handle assembly 100. However, it is contemplatedthat engaging portion 240 of elongate body assembly 200 may bethreadably connected with handle member 110.

With brief reference to FIG. 7, outer body 220 and engaging member 240define a longitudinal lumen 230 of varying diameter, through whichactuation rod 560 (FIG. 4) of actuation assembly 500 is at leastpartially slidably disposed, as will be described in detail hereinbelow.In particular, lumen 230 has a first portion 230 a and a second portion230 b. First portion 230 a of lumen 230 a has a larger diameter thanthat of second portion 230 b. The second portion 230 b extends from adistal end of outer body 220 to a point along outer body 220, and firstportion 230 a extends from the point on outer body 220 to a proximal endof engaging member 240 configured to be disposed within a portion ofchannel 115 of handle member 110.

With reference now to FIGS. 6 and 7, outer body 220 defines a pair ofopposing cavities 228 adjacent engaging member 240 configured to bedisposed within a portion of handle member 110. In particular, cavities228 are configured and dimensioned to receive a pair of pins 4, 6 (FIG.5) coupling actuation rod 560 with actuator member 550. Cavities 228 areconfigured and dimensioned to enable longitudinal movement of pins 4, 6therein, as will be described hereinbelow.

With continued reference to FIGS. 6 and 7, the distal end portion ofouter body 220 defines lateral recess portions 227. Each lateral recessportion 227 is configured and adapted to receive a support plate 320(FIG. 9). In addition, the distal end portion of outer body 220 includesa seating protrusion 280 configured and adapted to accommodate at leasta portion of laminar hook 50, as will be discussed hereinbelow.

With reference now to FIGS. 6-9, retaining portion 300 is configured toreleasably retain laminar hook 50 therein. Retaining portion 300includes a pair of support plates 320 disposed within respective lateralrecess portions 227. Each support plate 320 defines a pair of bores 322configured and dimensioned to receive pins 8 therethrough to securelyengage support plate 320 with lateral recess portions 227 of outer body220. Outer body 220 defines a pair of corresponding bores 288. Inparticular, the pair of bores 288 is arranged such that longitudinalmovement of actuation rod 560 within lumen 230 is not affected by pins 8therein. Specifically, pins 8 do not extend through lumen 230, and thuspins 8 are used to secure both support plates 320 to respective lateralrecess portions 227.

With particular reference to FIG. 9, each support plate 320 includes asubstantially flat portion that is disposed in lateral recess portion227 of outer body 220. In addition, each support plate 320 includes aretaining member 340 that generally conforms to the contour of seatingprotrusion 280 of outer body 220. Moreover, retaining member 340includes a contact surface 342 that engages a lateral surface of seatingprotrusion 280. Furthermore, each retaining member 340 defines a groove360 (FIG. 9A) that is adapted to receive at least a portion of archedportion 54 of laminar hook 50 therein. Moreover, retaining member 340includes a guide portion 361 (FIG. 9A) configured and dimensioned toengage groove 55 defined in each lateral side of arched portion 54 oflaminar hook 50.

With reference back to FIGS. 4 and 5, laminar hook insertion device 10further includes actuation assembly 500 operatively coupled with alaminar hook 50 (FIG. 11) releasably disposed in retaining portion 300.Actuation assembly 500 includes an actuation rod 560 and an actuatormember 550. Actuation rod 560 includes a first portion 524 and a secondportion 522 extending distally from first portion 524. First portion 524has a larger diameter than that of second portion 522. The diameters offirst and second portions 230 a, 230 b of lumen 230 substantiallycorrespond to those of first and second portions 524, 522 of actuationrod 560, respectively.

With continued reference to FIG. 4, actuation rod 560 is slidablydisposed in lumen 230 defined in outer body 220 and engaging member 240of elongate body assembly 200. In particular, a proximal end portion ofactuation rod 560 engages a distal end portion of biasing member 130disposed within a proximal portion of first portion 230 a of lumen 230.A distal end portion of actuation rod 560 is adapted to securely andreleasably engage a recess 58 (FIG. 11) defined in laminar hook 50disposed in retaining portion 300, whereby distal end portion ofactuation rod 560 protrudes slightly through a distal end of lumen 230of elongate body assembly 200.

With continued reference to FIGS. 4 and 5, actuator member 550 includesa base portion 552 and a pair of opposing guide members 554 extendingfrom base member 552. Actuator member 550 defines a U-shapedcross-section defining a recess 530. Actuator member 550 is mounted on aportion of outer member 220, and is operatively coupled with actuationrod 560 disposed in lumen 230 of elongate body assembly 200. Inparticular, pins 4, 6 couple actuator member 550 with actuation rod 560.Specifically, pins 4, 6 are received through bores 506 defined inopposing guide members 554 and bores 590 defined in first portion 524 ofactuation rod 560 through cavity 228 defined in outer body 220. In thismanner, actuator member 550 mounted on at least a portion of outer body220 is slidable along cavity 228 of outer body 220, which in turnimparts longitudinal movement to actuation rod 560 slidably disposedwithin lumen 230 defined in elongate body assembly 200.

However, movement of actuation rod 560 is limited by biasing member 130in the proximal direction and by second portion 230 b of lumen 230 whichdefines a smaller diameter than that of first portion of 524 ofactuation rod 560 in the distal direction. Accordingly, when biasingmember 130 is in a neutral state, i.e., unactuated state (FIG. 11),biasing member 130 urges actuation rod 560 to the distal-most positionwithin lumen 230. Specifically, a distal end portion of first portion524 of actuation rod 560 engages a proximal end portion of secondportion 230 b of lumen 230, whereby the smaller diameter of secondportion 230 b of lumen 230 inhibits distal movement of first portion 524of actuation rod 560 therethrough. More importantly, at this time, thedistal end portion of second portion 522 of actuation rod 560 slightlyextends out of the distal end of lumen 230, whereby recess 58 of laminarhook 50 is securely engaged with a distal end portion of actuation rod560 in retaining portion 300. In addition, the distal and proximallimits of actuation rod 560 is further defined by cavity 228 defined inouter member 220 of elongate body portion 200, in which pins 4, 6slidably move therein.

With reference to FIG. 11, when biasing member 130 is in the neutralstate, a distal end portion of actuation rod 560 protrudes slightlythrough the distal end of lumen 230 of outer member 220 and releasablyengages recess 58 of laminar hook 50. Arched portion 54 of hook 50conforms to the contour of seating protrusion 280 (FIG. 9) of an outerbody 220 to help securely retain laminar hook 50 in retaining portion300. At this time, pin 4 connected to actuator member 550 is disposed inthe distal-most position in cavity 228 defined in outer body 220 (FIG.12). However, as actuator member 550 is slidably moved in the proximaldirection by the surgeon, actuation rod 560 is also moved proximally asa single construct with actuator member 550 against the bias of biasingmember 130. Such movement disengages the distal end portion of actuationrod 560 from recess 58 of laminar hook 50. Upon release of actuatormember 550, the bias of biasing member 130 urges actuation rod 560 tothe distal-most position, which in turn positions pin 4 connected toactuator member 550 to the distal-most position in cavity 228 defined inouter body 220.

Prior to the surgical procedure, laminar hook 50 is attached toretaining portion 300 of laminar hook insertion device 10 by slidingactuator member 550 in the proximal direction which in turn movesactuation rod 560 proximally to facilitate positioning of laminar hook50 in retaining portion 300. Upon positioning laminar hook 50 inretaining portion 300, actuator member 560 is released to urge actuationrod 560 in the distal direction, whereby the distal portion of actuationrod 560 engages recess 58 defined in arched portion 54 of laminar hook50. The secure attachment of laminar hook 50 to laminar hook insertiondevice 10 enables the surgeon to safely manipulate and deliver laminarhook 50 to the surgical site of interest.

In use, the surgeon accesses the patient's spine in a known mannereither using open surgical techniques or minimally invasive techniques,and prepares the bone to receive screws, as is deemed appropriate underthe circumstances. The surgeon can position arched portion 54 of laminarhook 50 to engage, for example, the undersurface of the lamina, andinsert a bone screw into the bone through threaded bore 56 of laminarhook 50. For example, the bone screw may be a pedicle screw 80 (FIG. 14)including a shank 82 and a collet 84. Pedicle screw 80 may be of arigid, unitary design or may be polyaxial. Examples of polyaxial screwsare found in U.S. Pat. Nos. 5,733,286; 5,683,392 and 6,451,021, theentire contents of which are incorporated herein by reference. Collet 80is configured and dimensioned to receive a head of shank 82 such thatcollet 80 and the head are rotatable and pivotable in relation to eachother, thereby allowing shank 82 to be repositioned in a plurality oforientations relative to collet 80.

Alternatively, the bone screw may be a multi-planar taper lock screw(not shown) that enables manipulation of a screw shaft about multipleaxes, whereby the bone screw is capable of securing connecting rod 70with bone screws on multiple vertebral bodies that are aligned in thespinal column on different planes due to the curvature of the spine.However, it is also envisioned that the bone screws may be, for example,uniplanar screws and monoaxial taper lock screws.

Multi-planar taper lock bone screw includes a dual layered housing andscrew shaft having a spherically configured screw head rotatably coupledwith the housing. In particular, the dual layered housing includes anouter housing and an inner housing. The outer housing can be selectivelypositioned relative to the inner housing to fully lock the screw headand connecting rod 70 in position within the inner housing oralternatively to selectively partially lock the screw head and/orconnecting rod 70 in position while permitting a sliding and/or rotatingmotion of connecting rod 70 and the screw head, respectively, relativeto the bone screw.

Specifically, the outer housing is configured such that at least aportion of an inner surface of the outer housing is capable of slidingover a portion of an outer surface of the inner housing in upward anddownward directions along the longitudinal axis of the bone screw. Whenthe outer housing is slid upward in relation to the inner housing aninner surface of the outer housing causes the inner housing to impartcompressive force radially inward to secure connecting rod 70 at leastpartially disposed therein. One suitable taper lock screw iscommercially available from K2M, Inc. (Leesburg, Va.) under the tradename MESA™. In addition, suitable multi-planar taper lock screws areshown and described in U.S. Patent Application Publication 2008/0027432and in U.S. Patent Application Publication 2007/0093817, both of whichare herein incorporated by reference in their entireties. A screw headhaving a rod receiving notch is disclosed in commonly assigned U.S.patent application Ser. Nos. 11/493,524 and 11/493,625, the completedisclosures of which are fully incorporated herein by reference. Anexample of a rod reducer is disclosed in commonly assigned U.S. Pat. No.7,771,430, the entire contents of which are fully incorporated herein byreference.

Thereafter, the surgeon reduces connecting rod 70 into the rod receivingnotch of the screw head. The surgeon then uses the locking instrument tolock or partially lock each screw to rod 70. Advantageously, the surgeonmay partially lock each screw and before finishing the locking step mayreadjust the arrangement of the screws and rods 70. Upon completion ofnecessary adjustments, the surgeon can then fully lock each screw withthe locking instrument.

Although the illustrative embodiments of the present disclosure havebeen described herein with reference to the accompanying drawings, theabove description, disclosure, and figures should not be construed aslimiting, but merely as exemplifications of particular embodiments. Forexample, laminar hook 50 may be utilized to extend around the pedicle“P” in the region of the inferior vertebral notch to provide enhancedstability and fixation of the pedicle screw, as shown in FIG. 15. It isto be understood, therefore, that the disclosure is not limited to thoseprecise embodiments, and that various other changes and modificationsmay be effected therein by one skilled in the art without departing fromthe scope or spirit of the disclosure.

1. (canceled)
 2. A method of stabilizing a spine comprising: positioninga laminar hook on a retaining portion of a surgical hook insertiondevice by linearly inserting a guide protrusion of the retaining portioninto a groove defined in the laminar hook, such that an acute angledefined by a guide protrusion axis of the guide protrusion and alongitudinal axis defined by the surgical hook insertion device is afixed angle while the laminar hook is slidably released along an axisfrom the hook retaining portion; releasably securing the laminar hook onthe retaining portion of the surgical hook insertion device bytransitioning an actuation rod from a first position in which theactuation rod is disengaged from the laminar hook to a second positionin which a portion of the actuation rod is engaged with the laminarhook; positioning the laminar hook adjacent a bone of the spine;implanting a bone screw into the bone through the laminar hook;inserting a connecting rod into a connecting rod slot in the bone screw;and locking the connecting rod in the connecting rod slot in the bonescrew.
 3. The method according to claim 2, further comprising bendingthe connecting rod prior to inserting the connecting rod into theconnecting rod slot in the bone screw.
 4. The method according to claim3, wherein bending the connecting rod includes bending the connectingrod to conform to a desired contour of the spine.
 5. The methodaccording to claim 2, wherein releasably securing the laminar hook onthe retaining portion of the surgical hook insertion device includestransitioning the actuation rod from the first position in which theportion of the actuation rod is disengaged from a recess defined in anarched portion of the laminar hook to the second position in which theactuation rod is engaged with the recess of the arched portion of thelaminar hook.
 6. The method according to claim 5, wherein positioningthe laminar hook adjacent the bone includes positioning the archedportion of the laminar hook on an undersurface of a lamina of the spine.7. The method according to claim 5, wherein positioning the laminar hookadjacent the bone includes positioning the arched portion of the laminarhook around a pedicle of the spine.
 8. The method according to claim 2,wherein implanting the bone screw to the bone through the laminar hookincludes inserting the bone screw through a threaded bore defined in ahead portion of the laminar hook.
 9. A method of stabilizing a spinecomprising: positioning a laminar hook on a retaining portion of asurgical hook insertion device by linearly inserting a guide protrusionof the retaining portion into a groove defined in the laminar hook, suchthat the guide protrusion is rotationally fixed with respect to alongitudinal axis of the surgical hook insertion device while thelaminar hook is translatably released from the hook retaining portion ofthe surgical hook insertion device; securing the laminar hook on theretaining portion of the surgical hook insertion device by transitioningan actuation rod from a first position in which the actuation rod isdisengaged from the laminar hook and a second position in which aportion of the actuation rod is engaged with the laminar hook;positioning the laminar hook on a bone of the spine; securing a bonescrew to the bone through the laminar hook; inserting a connecting rodinto a connecting rod slot in the bone screw; and locking the connectingrod in the connecting rod slot in the bone screw.
 10. The methodaccording to claim 9, further comprising bending the connecting rodprior to inserting the connecting rod into the connecting rod slot inthe bone screw.
 11. The method according to claim 9, wherein bending theconnecting rod includes bending the connecting rod to conform to adesired contour of the spine.
 12. The method according to claim 9,wherein securing the laminar hook on the retaining portion of thesurgical hook insertion device includes transitioning the actuation rodfrom the first position in which the portion of the actuation rod isdisengaged from a recess defined in an arched portion of the laminarhook to the second position in which the actuation rod is engaged withthe recess of the arched portion of the laminar hook.
 13. The methodaccording to claim 12, wherein positioning the laminar hook adjacent thebone includes positioning the arched portion of the laminar hook on anundersurface of a lamina of the spine.
 14. The method according to claim12, wherein positioning the laminar hook adjacent the bone includespositioning the arched portion of the laminar hook around a pedicle ofthe spine.
 15. The method according to claim 9, wherein securing thebone screw to the bone through the laminar hook includes inserting thebone screw through a threaded bore defined in a head portion of thelaminar hook.